Muscle Fiber Orientation in the Development and Regression of Right Ventricular Hypertrophy in Pigs

The development and regression of right ventricular hypertrophy was investigated in 12 pigs with special reference to changes in ventricular function and myocardial fiber orientation. Nine ventricles were pressure -loaded by banding the pulmonary artery for 28–81 days, and four of them were then released from the load by removing the band. Right ventricular systolic pressure (RVSP), end-diastolic pressure (RVEDP) and end systolic volume index (ESVI) increased significantly during banding and decreased after debanding. End diastolic volume index (EDVI) and stroke volume index (SVI) showed no significant change during banding and after debanding. The weight of the right ventricle relative to both ventricles (RV/TV) and the thickness of muscle fibers were increased significantly in the loaded ventricles, and reduced again to the control level in ventricles released from the load. The intramyocardial distribution of angles ( θ ) of inclination of muscle fibers from the transverse plane of the outflow tract was estimated histometrically. There was a significantly larger proportion of circularly oriented fibers (|θ|≦30) in the pressure loaded ventricles than in the control, whereas these fibers decreased again to the control level after removal of the pressure load. The present findings indicates that 1) the right ventricular hypertrophy induced by pressure loading is characterized not only by an increase in ventricular weight and muscle fiber thickness, but also by a change in intramyocardial fiber orientation, and 2) the hypertrophic right ventricle can regress both functionally and morphologically to a normal state after removal of the pressure load.     

Determinants of Right Ventricular Muscle Mass in Idiopathic Dilated Cardiomyopathy: Impact of Left Ventricular Muscle Mass and Pulmonary Hypertension

Introduction: Although chronic pulmonary hypertension and right ventricular (RV) function carry important functional and prognostic implications in idiopathic dilated cardiomyopathy (IDC), little information on RV muscle mass (RVMM) and its determinants has been published.Methods: Our study comprised thirty-five consecutive patients with IDC, left ventricular (LV) ejection fraction <40% and NYHA class ≥2. Hemodynamic data and parameters on LV and RV geometry were derived from right heart catheterisation and cardiac magnetic resonance imaging.Results: RVMM was normalized to body size using a common linear, body surface area based approach (RVMMI) and by an allometric index (RVMM-AI) incorporating adjustment for age, height and weight. Stepwise multiple regression analysis revealed that pulmonary artery pressure and left ventricular muscle mass were independent predictors of RVMM-AI. The interventricular mass ratio of RV and LV mass (IVRM) was closely related to RVMM (r = 0.79, p < 0.001) and total muscle mass (r = 0.39, p < 0.02). However, there was no significant relationship between LVMM and IVMR (r = 0.17, p = 0.32).Conclusion: Our data suggest that an increase in RV mass in IDC may be explained by two mechanisms: First, as a consequence of the myopathic process itself resulting in a balanced hypertrophy of both ventricles. Second, due to the chamber specific burden of pulmonary artery pressure rise, resulting in unbalanced RV hypertrophy.     

肾上腺髓质素m RNA在慢性缺氧大鼠右心室中的表达

目的:探讨肾上腺髓质素(AM)在慢性低氧性肺动脉高压发病中的作用。方法:16只大鼠随机分为低氧组和对照组,间断常压低氧14d复制肺动脉高压模型,静脉右心导管测定右室收缩压(RVSP)的变化,分离心室检测右室/(左室+室间隔)(RV/LV+SP)比值,原位杂交法检测AMmRNA在右心室中的表达。结果:低氧组大鼠右室压为(63.63±3.42)mmHg,显著高于对照组的(34.13±3.40)mmHg(P<0.01)。低氧组大鼠(RV/LV+SP)比值为0.439±0.039,显著高于对照组的0.23±0.025(P<0.01)。AMmRNA在对照组大鼠的右室心肌细胞也有少量表达,低氧组大鼠其表达显著多于对照组。图像分析表明,低氧组的平均吸光度、平均表达面积分别为0.1061±0.0188,0.1421±0.0165,均显著高于对照组的0.0872±0.0171,0.0967±0.0135。结论:低氧时右心室AMmRNA表达增加,提示可能在肺动脉高压的发病中起保护作用。     

Pulmonary arterial hypertension in male and female chickens at 3300 m

Two-hundred one-day-old male (M) and female (F) chickens were exposed to 3300m (HA). Two-hundred control chickens were raised at sea level (SL). Chickens from both HA and SL were studied each week from the 3rd to the 7th week of age. Pulmonary arterial pressure (Ppa) was measured under local anesthesia in conscious animals. Hb, Hct and red blood cell counts (E) and the weights of the right ventricle (RV), left ventricle (LV) and septum (S) were obtained. HA chickens, both males and females, reached lower body weights than SL chickens.Ppa were 16 and 43 mm Hg (2.13 and 5.73 kPa) while RV/(RV+LV+S) values were 0.195 and 0.347 in SL and HA chickens, respectively. RV was 90% greater and LV 20% smaller in the HA chickens. S was not affected by altitude. Hb, Hct and E were higher in the HA birds. Sixteen HA M and 1 HA F died with signs of right heart insufficiency (RHI), however, M did not show greater values ofPpa or RV/(RV+LV+S) than F at SL or at HA. This indicates that the higher incidence of RHI in the M cannot be attributed to a higher responsiveness of their pulmonary vasculature to hypoxia.     

三七总皂苷对低氧大鼠肺动脉压和肺组织p38 MAPK表达的影响

目的:探讨三七总皂苷(PNS)对低氧大鼠p38丝裂原活化蛋白激酶(p38 MAPK)表达的影响,及预防低氧性肺动脉高压(HPH)的作用和机制。方法:将30只SD大鼠随机分为3组:正常对照组、低氧组和低氧+PNS组。观察各组大鼠平均肺动脉压(mPAP)、平均颈动脉压(mCAP)和右心室/(左心室+室间隔重量)比[RV/(LV+S)],免疫组化法和RT-PCR法分别检测肺小血管壁磷酸化p38 MAPK(p-p38 MAPK)蛋白和肺组织中mRNA的含量。结果:与对照组相比,低氧组大鼠mPAP、RV/(LV+S)明显升高,肺小动脉p-p38 MAPK及肺组织p38 MAPK mRNA含量显著升高(P0.05)。低氧+PNS组mPAP、RV/(LV+S)、肺小动脉p-p38 MAPK及肺组织p38 MAPK mRNA含量明显低于低氧组(P0.05)。结论:PNS具有显著预防HPH的作用,其机制可能与其降低p38 MAPK mRNA的表达有关。     

The effects of asymmetric ventricular filling on left–right ventricular interaction in the normal rat heart

Heart failure is characterised by ventricular dysfunction and with the potential for changes to ventricular volumes constraining the mechanical performance of the heart. The contribution of this interaction from geometric changes rather than fibrosis or metabolic changes is unclear. Using the constant pressure Langendorff-perfused rat heart, the volume interaction between left ventricle (LV) and right ventricle (RV) was investigated. RV diastolic stiffness (P?<?0.001) and developed pressure (P?<?0.001) were significantly lower than LV. When the RV was fixed at the end-diastolic volume (EDV) or EDV?+?50?%, both LV systolic and diastolic performance were unaffected with increasing LV balloon volume. However, at fixed LV volume, RV systolic performance was significantly decreased when LV volume increased to EDV?+?50?% when RV volume was increased incrementally between 50 and 300?μl (P?<?0.001). Systolic interaction in RV was noted as declining RV peak systolic load with increasing LV systolic pressure (P?<?0.05) and diastolic interaction was noted for RV when LV volume was increased from EDV to EDV?+?50?% (P?<?0.05). RV diastolic wall stress was increased with increasing LV balloon volume (P?<?0.05), but LV wall stress was unaltered at fixed RV balloon volume. Taken together, increasing LV volume above EDV decreased systolic performance and triggered ventricular constraint in the RV but the RV itself had no effect on the performance of the LV. These results are consistent with overload of the LV impairing pulmonary perfusion by direct ventricular interaction with potential alteration to ventilation–perfusion characteristics within the lung.     

Right ventricular function with hypoxic exercise: effects of sildenafil

The effect of sildenafil on right ventricular contractility in hypoxic exercise is unknown, whereas reports have shown that sildenafil is associated with a smaller increase in pulmonary vascular resistance and right ventricular systolic pressure (RVSP) with exercise at high altitude. The present study evaluates the changes induced by controlled hypoxia on right ventricular pressure and performance with and without sildenafil administration. Tricuspid annular isovolumic acceleration (IVA) and annular velocities were measured in 14 healthy subjects at rest and after maximal exercise in a cross-over, double blind placebo controlled trial in three situations: normoxia, normobaric hypoxia with, and normobaric hypoxia without the administration of 100 mg sildenafil. RVSP, assessed by Doppler echocardiography, was determined from the peak tricuspid regurgitation pressure gradient. RVSP during rest increased from 26.9 ± 2.3 mmHg in normoxia to 37.8 ± 6.9 mmHg in hypoxia, p < 0.01; sildenafil administration reduced RVSP in hypoxia to 30.5 ± 5.6, p < 0.01. Compared to normoxia at rest, IVA increased similarly with peak exercise in normoxia and hypoxia_sildenafil (by 2.37 and 1.90 m/s², respectively), but the observed increase in IVA during exercise was smaller (0.86 m/s², p < 0.05) in hypoxia_placebo. Right ventricular contractility, as estimated by IVA at peak exercise is increased with the administration of sildenafil as compared to placebo, and is not different from the values seen during exercise in normoxia. This effect seems independent of the effect of sildenafil on RVSP.     

Acute effects of pulmonary artery banding in sheep on right ventricle pressure–volume relations: relevance to the arterial switch operation

The first stage of the two‐stage arterial switch operation (ASO) for transposition of the great arteries (TGA) is associated with depressed ventricular function and an unstable immediate post‐operative course. It is unclear if this is because of the acute increase in afterload of the thin‐walled, low‐pressure ventricle by pulmonary artery banding (PAB). To determine the acute effects of afterload increase on the contractile function of thin‐walled ventricles, we studied the right ventricular pressure–volume relations of seven sheep before and 30 min after PAB using combined pressure–conductance catheters during inflow reduction. Load independent indices of systolic and diastolic performance were derived from these relations. Pulmonary artery banding increased the mean ratio between right and left ventricular systolic pressure from 0.34 ± 0.05 to 0.64 ± 0.10, P < 0.05 (mean ± SD). There were no significant changes in heart rate and end‐systolic volume after banding although there was an incremental trend in the end‐diastolic volume and stroke volume. Right ventricular output (530 ± 163–713 ± 295 mL min^–1, P < 0.05), slope of the end‐systolic pressure–volume relation (ESPVR) (3.7 ± 2.8–10.0 ± 4.8 mmHg mL^–1, P < 0.05) and slope of the pre‐load recruitable stroke work (PRSW) relation (9.6 ± 1.8–15.0 ± 3.1 mmHg, P < 0.05) were significantly increased indicating improved contractile state after banding. The diastolic function curve was unchanged after banding although the right ventricle (RV) was operating at a larger end‐diastolic volume. Hence, the RV of sheep responded to acute pressure overload by demonstrating enhanced contractility and evidence of the Frank–Starling mechanism without associated change in right ventricular diastolic performance.     

ANP gene expression in rat hearts during hypoxia

 It is unclear whether the increase in plasma atrial natriuretic peptide (ANP) concentration during hypoxia is due to direct, hypoxia-induced upregulation of ANP secretion in the heart, or to pressure overload of the right ventricle (RV) following hypoxia-induced pulmonary hypertension. To test the hypothesis that hypoxia leads to an early upregulation of the ANP gene, we examined the influence of acute and prolonged inspiratory hypoxia (6 h, 1 or 3 weeks) on the expression of ANP messenger ribonucleic acid (mRNA) in rat heart and compared the results with the expression of the ANP gene after acute pressure overload induced by experimental coarctation of the main pulmonary artery. As a molecular marker for hypertrophy we determined the ratio of α- and β-myosin gene expression. Hypoxia increased systolic RV pressure from 20.0 ± 1.6 mmHg to 27.8 ± 1.6 mmHg (P < 0.01) and 41.6 ± 2.1 mmHg (P < 0.05) after 1 and 3 weeks hypoxia respectively. The ANP plasma concentration did not change significantly after 6 h or 1 week: 232 ± 21 pg/ml (control), 246 ± 25 pg/ml (6 h), 268 ± 25 pg/ml (1 week), but increased significantly after 3 weeks hypoxia (446.8 ± 99.56 pg/ml; P < 0.05). ANP mRNA levels in different regions of the heart did not change after 6 h or 1 week hypoxia. After 3 weeks hypoxia ANP mRNA had increased 2.7-fold in the RV (P < 0.05), 4.2-fold in the left ventricle (LV, P < 0.05), 3.5-fold in the septum (S, P < 0.05) and about 1.4-fold in the right (n.s.) and left atrium (n.s.). Relative ventricular masses increased significantly only for the RV (190%, P < 0.05) during hypoxia. The β/α-myosin mRNA ratio did not change after 6 h hypoxia but, contrary to ANP gene expression, increased after just 1 week (6.1-fold in RV, 7.8-fold in LV, 6-fold in S; P < 0.05) and was more pronounced in the RV after 3 weeks (9.4-fold in RV, 7.6-fold in LV, 9.1-fold in S; P < 0.05). The increase in the β/α-myosin mRNA ratio in the LV contrasts with a lack of increase in relative ventricular mass. Acute pressure overload in the RV after pulmonary arterial banding significantly increased ANP-mRNA and the β/α-myosin mRNA ratio after 1 day in the RV. In the LV ANP mRNA was unchanged. The delayed upregulation of the ANP gene suggests that hypoxia per se is not a significant stimulus for ANP gene expression in the heart and that hypoxia-induced ANP-gene expression in the heart is regulated predominantly by the increase in RV afterload due to hypoxia-induced increased pulmonary pressure. The upregulation of ANP and β-myosin mRNA in the LV during chronic hypoxia has yet to be elucidated. Received: 5 November 1996 / Received after revision and accepted: 24 January 1997     

Recovery from hypoxic pulmonary hypertension in rats

To characterize the time frame of changes in pulmonary arterial pressure, right ventricular hypertrophy and morphology of small pulmonary arteries male Wistar rats were exposed to isobaric hypoxia (3 weeks, F1O2 0.1) and then let to recover on air for 1 or 5 weeks. Normoxic animals (group N) served as controls. Mean pulmonary arterial pressure (PAP), ratio of the weight of the right heart ventricle to the sum of the weights of the left ventricle and septum (RV/LV+S) and percentage of double laminated pulmonary vessels ( % DL) were measured at the end of hypoxic exposure (group H), after 1 or 5 weeks of recovery (groups 1R and 5R), and in controls kept in air (group N). Three weeks in hypoxia resulted in increase in PAP, RV/LV+S and % DL. After 1 week of recovery RV/LV+S normalized, PAP decreased, while % DL did not change. After 5 weeks in air PAP returned to control values and % DL diminished significantly but did not normalize. Our results suggest that recovery depends on the degree of HPH and that knowledge of the time-frame of recovery is important for future studies in our rat model.     

吸氧对高原动物心和肺功能的影响

我们观察了9只高原猪吸氧后的心肺功能变化。高原猪吸入纯氧后,右室收缩压、右室dp/dt max、肺动脉压和肺血管阻力明显降低,但左室dp/dt max、心指数、主动脉压和外周阻力无明显变化。这些结果提示肺血管收缩在慢性缺氧性肺动脉高压的发生中起重要作用。吸入纯氧后右室dp/dtmax下降,这表明慢性缺氧可致右室功能增加而肺分流率下降,提示高原幼猪存在肺通气/灌流不均。     

Early neonatal echocardiographic findings in an experimental rabbit model of congenital diaphragmatic hernia

This study aimed to demonstrate that congenital diaphragmatic hernia (CDH) results in vascular abnormalities that are directly associated with the severity of pulmonary hypoplasia and hypertension. These events increase right ventricle (RV) afterload and may adversely affect disease management and patient survival. Our objective was to investigate cardiac function, specifically right ventricular changes, immediately after birth and relate them to myocardial histological findings in a CDH model. Pregnant New Zealand rabbits underwent the surgical procedure at 25 days of gestation (n=14). CDH was created in one fetus per horn (n=16), and the other fetuses were used as controls (n=20). At term (30 days), fetuses were removed, immediately dried and weighed before undergoing four-parameter echocardiography. The lungs and the heart were removed, weighed, and histologically analyzed. CDH animals had smaller total lung weight (P<0.005), left lung weight (P<0.005), and lung-to-body ratio (P<0.005). Echocardiography revealed a smaller left-to-right ventricle ratio (LV/RV, P<0.005) and larger diastolic right ventricle size (DRVS, P<0.007). Histologic analysis revealed a larger number of myocytes undergoing mitotic division (186 vs 132, P<0.05) in CDH hearts. Immediate RV dilation of CDH hearts is related to myocyte mitosis increase. This information may aid the design of future strategies to address pulmonary hypertension in CDH.     

Acute effects of pulmonary artery banding in sheep on right ventricle pressure-volume relations: relevance to the arterial switch operation.

The first stage of the two-stage arterial switch operation (ASO) for transposition of the great arteries (TGA) is associated with depressed ventricular function and an unstable immediate post-operative course. It is unclear if this is because of the acute increase in afterload of the thin-walled, low-pressure ventricle by pulmonary artery banding (PAB). To determine the acute effects of afterload increase on the contractile function of thin-walled ventricles, we studied the right ventricular pressure-volume relations of seven sheep before and 30 min after PAB using combined pressure-conductance catheters during inflow reduction. Load independent indices of systolic and diastolic performance were derived from these relations. Pulmonary artery banding increased the mean ratio between right and left ventricular systolic pressure from 0.34 +/- 0.05 to 0.64 +/- 0.10, P < 0.05 (mean +/- SD). There were no significant changes in heart rate and end-systolic volume after banding although there was an incremental trend in the end-diastolic volume and stroke volume. Right ventricular output (530 +/- 163-713 +/- 295 mL min (-1), P < 0.05), slope of the end-systolic pressure-volume relation (ESPVR) (3.7 +/- 2.8-10.0 +/- 4.8 mmHg mL (-1), P < 0.05) and slope of the pre-load recruitable stroke work (PRSW) relation (9.6 +/- 1.8-15.0 +/- 3.1 mmHg, P < 0.05) were significantly increased indicating improved contractile state after banding. The diastolic function curve was unchanged after banding although the right ventricle (RV) was operating at a larger end-diastolic volume. Hence, the RV of sheep responded to acute pressure overload by demonstrating enhanced contractility and evidence of the Frank-Starling mechanism without associated change in right ventricular diastolic performance.     

Comparative effects of isosorbide dinitrate, prednisolone, indomethacin, and elastase on the development of monocrotaline-induced pulmonary hypertension

The pathogenesis of monocrotaline-induced pulmonary hypertension is not clear. Progressive pulmonary arteritis leading to vascular sclerosis, narrowing of the lumina, and thrombosis is the suspected sequence. To investigate this, we examined the effect of isosorbide dinitrate (ISDN), prednisolone, indomethacin, and elastase in 100 SD male rats, 4 weeks after the injection of monocrotaline (MCT) by cardiac catheterization, right ventricle-to-left ventricle plus septum weight ratio (RV/LV + S), histology, and electron microscopy. ISDN, a vasodilator, reduced the elevation of right ventricular (RV) pressure, RV/LV + S, and also pulmonary vascular remodeling; the characteristic histological feature was dilatation of small pulmonary arteries. Both prednisolone and indomethacin reduced RV pressure, RV/LV + S, and pulmonary vasculitis. Elastase, a protease which controls the metabolism of elastin in the arterial wall, likewise reduced RV pressure, RV/LV + S, and pulmonary vascular remodeling, with a significant decrease in elastosis of the small pulmonary arteries histologically. We concluded that all of the pathological processes resulting from arteritis are important in the development of MCT-induced pulmonary hypertension. In all experimental groups, decreased histopathologic changes correlated with decrease in the pressure. Elastase, which reduces pulmonary arterial sclerosis, is suggested as a new agent to treat pulmonary hypertension.     

Evaluation of the HeartWare HVAD centrifugal pump for right ventricular assistance in an in vitro model

We have developed a method that allows the use of a commercially available implantable left ventricular assist device (LVAD; HeartWare HVAD) for right ventricular (RV) assistance. A mock circulation was used to examine the flow characteristics of the system with different outflow diameters (10-4 mm). Furthermore, we looked for a material for safe and satisfactory reduction of the effective length of the inflow cannula for better fitting to the RV dimensions. Reduction of the outflow graft to an inner diameter of ～5 mm adds as much resistance to the system that in patients with a normal pulmonary resistance, the pump would deliver between 3.5 and 7 L/min. We added two 5 mm silicon suture rings to the system's "apical" sewing ring to reduce the effective length of the inflow cannula. Connection of the pump to the anterior free wall of the right ventricle ensures good orientation of the inflow cannula within the RV cavity, with sufficient space to prevent the inflow cannula from suction to the opposite interventricular septum. The HeartWare LVAD pump seems also to be usable as a right ventricular assist device (RVAD) after a few, but important, modifications of the implant procedure.     

缺氧性肺动脉高压大鼠右心室重构

摘要目的：研究缺氧性肺动脉高压大鼠右心室重构情况。方法：常压间断缺氧法复制缺氧性肺动脉高压大鼠模型，采用右心导管法测定平均肺动脉压力，通过测量右心室流入及流出道长度、左心室壁和右心室壁厚度、右心室和左心室 室间隔重量对其右心室重构情况进行定性研究。结果：缺氧14d后大鼠平均肺动脉压力显著升高，右心室流出道长度及右心室肥大指数显著增加，缺氧21d后右心室游离壁重量显著增加；右心室流人道长度及左、右心室壁厚度与对照组无统计学差异。结论：缺氧性肺动脉高压大鼠右心室早期表现为离心性肥大。     

Cerium oxide nanoparticles attenuate monocrotaline induced right ventricular hypertrophy following pulmonary arterial hypertension

Cerium oxide (CeO₂) nanoparticles have been posited to exhibit potent anti-oxidant activity which may allow for the use of these materials in biomedical applications. Herein, we investigate whether CeO₂ nanoparticle administration can diminish right ventricular (RV) hypertrophy following four weeks of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Male Sprague Dawley rats were randomly divided into three groups: control, MCT only (60 mg/kg), or MCT + CeO₂ nanoparticle treatment (60 mg/kg; 0.1 mg/kg). Compared to the control group, the RV weight to body weight ratio was 45% and 22% higher in the MCT and MCT + CeO₂ groups, respectively (p < 0.05). Doppler echocardiography demonstrated that CeO₂ nanoparticle treatment attenuated monocrotaline-induced changes in pulmonary flow and RV wall thickness. Paralleling these changes in cardiac function, CeO₂ nanoparticle treatment also diminished MCT-induced increases in right ventricular (RV) cardiomyocyte cross sectional area, β-myosin heavy chain, fibronectin expression, protein nitrosylation, protein carbonylation and cardiac superoxide levels. These changes with treatment were accompanied by a decrease in the ratio of Bax/Bcl2, diminished caspase-3 activation and reduction in serum inflammatory markers. Taken together, these data suggest that CeO₂ nanoparticle administration may attenuate the hypertrophic response of the heart following PAH.     

异甘草素对低氧诱导的大鼠肺动脉结构重建的影响

目的 观察异甘草素对缺氧性肺动脉高压（HPH）大鼠模型的肺动脉压力的变化,右心室肥厚程度及肺血管结构重建的影响,探讨异甘草素对HPH的抑制作用及其可能机制。方法 雄性SD大鼠30只随机分为对照组、HPH组、异甘草素组,每组各10只。HPH组和异甘草素组大鼠置于缺氧箱中建立大鼠HPH模型。异甘草素组中,每只大鼠腹腔注射异甘草素剂量为10 mg/(kg·d),从缺氧前1周开始给药直到缺氧结束。对照组和HPH组大鼠腹腔注射等体积0.5% DMSO。测定各组大鼠平均右心室压力(RVSP);称重法测得各组大鼠右心室游离壁（RV）及左心室加室间隔（LV+S）质量,以及RV/（LV+S）;HE染色观察肺动脉病理形态改变,计算血管厚度百分比(WT%)及面积百分比(WA%);ELISA法检测各组大鼠血清及肺组织中的超氧化物歧化酶(SOD)及丙二醛(MDA)的含量。Real-time PCR检测各组大鼠肺组织中的NADPH氧化酶4(NOX4) mRNA的表达。结果 HPH组大鼠RVSP、RV/LV+S、WT%,以及WA%明显高于对照组大鼠（P<0.01）,然而异甘草素组大鼠RVSP、RV/LV+S、WT%,以及WA%均明显低于HPH组大鼠（P<0.01）。HPH组大鼠肺组织及血清中的SOD含量较对照组明显降低,而MDA含量则明显增高（P<0.01）。异甘草素组大鼠肺组织及血清中的SOD含量较HPH组大鼠明显增高,而MDA含量则明显降低（P<0.01）。 Real time PCR结果显示,异甘草素有效抑制了低氧诱导的大鼠肺组织中NOX4 mRNA的高表达（P<0.01）。结论 异甘草素抑制由低氧诱导的HPH大鼠肺动脉压力升高、右心室肥厚,以及肺动脉管壁的增厚,可能与异甘草素抑制HPH大鼠体内的氧化损伤有关。     

Coupling pediatric ventricle assist devices to the Fontan circulation: simulations with a lumped-parameter model

In pediatric ventricular assist device (VAD) design, the process of matching device characteristics and dimensions to the relevant disease conditions poses a formidable challenge because the disease spectrum is more highly varied than for adult applications. One example arises with single-ventricle congenital defects, which demand palliative surgeries that create elevated systemic venous pressure and altered pulmonary hemodynamics. Substituting a mechanical pump as a right ventricle has long been proposed to eliminate the associated early and postoperative anomalies. A pulsatile lumped-parameter model of the single-ventricle circulation was developed to guide the preliminary design studies. Two special modules, the pump characteristics and the total cavopulmonary connection (TCPC) module, are introduced. The TCPC module incorporates the results of three-dimensional patient-specific computational fluid dynamics calculations, where the pressure drop in the TCPC anastomosis is calculated at the equal vascular lung resistance operating point for different cardiac outputs at a steady 60/40 inferior vena cava/superior vena cava flow split. Preliminary results obtained with the adult parameters are presented with no ventricle remodeling or combined larger-size single ventricle. A detailed literature review of single-ventricle function is provided. Coupling a continuous pump to the single-ventricle circulation brought both the pulmonary and systemic venous pressures back to manageable levels. Selected VADs provided an acceptable cardiac output trace of the single left ventricle, after initial transients. Remodeling of the systemic venous compliance plays a critical role in performance and is included in this study. Pulsatile operation mode with rotational speed regulation highlighted the importance of TCPC and pulmonary artery compliances. Four different pumps and three patient-specific anatomical TCPC pathologies were studied. Magnitudes of the equivalent TCPC resistances were found to be comparable to the vascular resistances of the normal baseline circulation, significantly affecting both the VAD design and hemodynamics.     

慢性缺氧致大鼠右心室心肌细胞凋亡及其机制研究

目的：通过建立大鼠慢性缺氧心肌肥大模型,探讨慢性缺氧致大鼠心肌细胞凋亡的发生规律及其机制。方法: 将大鼠随机分为慢性缺氧组和正常对照组,每组30只,慢性缺氧组置于氧浓度为(10.0±0.5)％的大型玻璃舱中,分别持续缺氧14、21、28 d,分别于第14、21、28 d处死大鼠,取心脏称重,留右心室,进行形态学观察,分析心肌细胞凋亡形态及计量,检测肌球蛋白β重链(β-MHC)、原癌基因B淋巴细胞瘤-2（bcl-2）、Bad 等mRNA及Bcl-2、Bad蛋白的表达水平。结果: (1)慢性缺氧14、21、28 d组大鼠右心室/（左心室+室间隔）［RV/(LV+S)］、右心室/体重（RV/BW）比值及右心室β-MHC mRNA和蛋白表达均明显高于正常对照组(均Ｐ<0.01),并且随时间延长而增高(均Ｐ<0.01)。(2) 慢性缺氧心肌细胞凋亡指数14、21、28 d组大鼠均明显高于正常对照组(均Ｐ<0.01),且随着时间的延长而增加(均Ｐ<0.01)。（3）慢性缺氧14、21、28 d组大鼠右心室bcl-2 mRNA表达和Bcl-2蛋白表达均明显低于正常对照组(均Ｐ<0.05),缺氧28 d组bcl-2 mRNA表达和Bcl-2蛋白表达较缺氧14 d组显著降低 (均Ｐ<0.05)。慢性缺氧14、21、28 d组大鼠右心室bad mRNA表达和Bad蛋白表达与正常对照组比较无明显改变 (均Ｐ>0.05)。（4）慢性缺氧14、21、28 d组大鼠右心室bcl-2/bad比值均明显低于正常对照组(均Ｐ<0.05),缺氧28 d组bcl-2/bad比值较缺氧14 d组显著降低 (Ｐ<0.05)。结论: 慢性缺氧可以诱导大鼠右心室心肌细胞凋亡和心肌肥大,且大鼠右心室心肌细胞凋亡和心肌肥大程度随着缺氧时间的延长而增加。慢性缺氧通过抑制大鼠右心室心肌细胞抗凋亡基因bcl-2表达,使bcl-2/bad比值下调,打破原有的平衡,导致心肌细胞凋亡。